My turn. Had this last night
"Attendings; let the students/terns have first crack at questions/details/advancing the case.
Snarky-ass comments welcome." - still applies!
26 yo woman p/w dizziness, vomiting, and not feeling well. Onset maybe 1 hour ago. Just had NSVD 7 days ago at OSH, treated for peripartum pre-eclampsia. She is otherwise healthy.
HR 125. BP 150/130. RR low 20s. SpO2 98% RA. Temp normal
She looks pale. A little sleepy. She looks kind of ill
She is speaking as if she has a bag of marbles in her mouth. I looked in her mouth and there aren't any.
I keep on having to yell her name, and her eyes will open and answer my questions.
Me: me yelling..."How do you feel?"
Her: She opens her eyes. "Yea I'm feeling OK. I'm nauseus." Then closes her eyes
Me: me yelling..."Do you have any pain?"
Her: she opens her eyes. "No not right now. maybe earlier had a headache. But I'm OK now." then closes her eyes
Me: me yelling..."do you have any chest pain, problems breathing, nausea, vomiting, diarrhea, any other pain anywhere?"
Her: she opens her eyes. "Umm....no." then closes her eyes.
Me: me yelling..."How did your delivery go? Any problems?"
Her: she opens her eyes. "yea it was fine...they said I had pre-mpns.dips.disbabdbaba. they gave me to much...umm..megnesssnimum" then closes her eyes.
Me: me yelling..."do you have any vaginal bleeding?"
Her: she opens her eyes. "yea some" then closes her eyes
Family isn't around. EMS said basically she was dizzy and started vomiting. That's about it.
I just decided to examine her because it was painful getting answers. I could only understand about 3/4 of what she said. It was dysarthria not dysphasia.
Ocular movements are not normal. She gazes normally to the left. Hard time gazing to the right. There was right horizontal nystagmus. I thought this was cool. There was a hot tech in the room and I said "psst! check this out!" I had the patient do it again and now she wasn't doing that nystagmus. (Internally I said dammit!!!!!")
Extremely easily moves all extremities like 6/5. Even kept pointed toes. She put her legs straight in the air. One of the nurses said "are you a dancer?" She opened her eyes, smiled, and said "yes I am" then closed her eyes.
Abd is very soft, no tenderness
No CVAT
Lungs clear
has 1-2+ pitting edema in legs
2+ patella reflexes b/l
Before you even ask.
FSG normal
Yes I get a stat Head CT and it's normal